The NHS Staff and Learners' Mental Wellbeing Commission has just released a report examining the mental health of healthcare students. Balancing academia with clinical practice is a struggle faced by healthcare students - and it's not just Junior Doctors who are affected. Nursing, pharmacy, and dentistry students too are expected to offer high quality care in often less than comfortable work conditions, as well keeping up with academic commitments.
Support for secondary school students seeking careers in healthcare
The Commission's report suggests that the wellbeing of NHS professionals can be improved before they even enter into the career or training.
Examining the wellbeing of the healthcare professionals of the future during their formative years, this section of the report focuses upon young people of secondary school age who may be considering future careers in the NHS.
"The current NHS workforce can do more to promote an acceptance that everyone has a continuum of mental health".
The report highlights that 60%-70% of young people fail to receive appropriate mental health interventions at a sufficiently early age, with half of lifetime mental illness manifesting by the age of fourteen. Given this, the report makes recommendations that aim to transform the journey of embarking upon a healthcare career "less stressful and more exiting". From accurate information about which A-Level subjects are required for particular degrees, to publicising the vast range of different routes into NHS careers, these recommendations should make healthcare career applications easier to navigate and therefore less damaging to a young person's wellbeing.
Factors such as having a learning disability or coming from a family with few "contacts" are highlighted as affecting prospective healthcare students. Although pupils with learning disabilities, if adequately supported by their school/college, experience little to no disadvantage, such pupils are likely to find the transition to higher or further education stressful because of worries about accessing appropriate support. And so, the reports calls for UCAS (The Universities and Colleges Admissions Service) to review its guidance for students with learning disabilities.
Having links between colleges and schools and the local NHS services would make healthcare work experience accessible for all. Due to being the largest employer in most areas, the NHS is able to offer a "bureau" service to provide students with work experience, even if their family lack the "contacts" to secure such experience independently from school.
Undergraduate healthcare students face unique challenges that may compromise their mental wellbeing
Whilst students entering higher education are now fives times more likely to disclose a mental health condition, research suggests that there is significant under-reporting from healthcare undergraduates in particular. Stressors likely to impact undergraduate students upon starting university are highlighted, with changes in living situations, having to adapt to a new educational system, and financial and social pressures affecting many.
Additional cultural factors increase an undergraduate student's risk of experiencing mental ill health. Students who are disabled, female, black, Asian, and minority ethnic (BAME), from less wealthy backgrounds, and LGBTQ+ (lesbian, gay, bisexual, transgender, or queer) are significantly vulnerable.
Research shows that healthcare students, from those on nursing degrees to medical degrees, experience higher levels of anxiety, depression, burnout, and personal distress compared to their non-healthcare student counterparts. High workload, ethical conflicts, and the intensity of both contact hours and clinical practice make healthcare students significantly stressed.
The report recommends training in self-care, self-awareness, suicide risk and prevention, and how to recognise when stress becomes a health problem for all healthcare students. Wellbeing "check-ins" should be provided to all healthcare students within two weeks of starting each placement. Having a personal wellbeing tutor would give students a space that is separate from the academic aspect of their degree in which they can be supported holistically.
Working conditions for students on clinical placements need to be improved. Access to toilets, a quiet area to relax in, reliable WiFi, and healthy food would make what is already a potentially stressful experience more comfortable. "There is good evidence that happy staff are more compassionate and provide safer care", says the report.
Healthcare students should be given clear guidance on the support procedures that are in place if they disclose that they are struggling with mental ill health. The Commission says that students who may fear the repercussions of disclosure must be provided with information to "allay their fears of any detrimental impact of this disclosure upon future career prospects".
Wellbeing of postgraduate healthcare students is yet to be sufficiently researched
Despite undertaking an extensive literature review, the Commission found research on the needs of postgraduate students as both learners and employees to be lacking.
Particular personality traits that make postgraduate learners successful in both academia and clinical practice may prove detrimental to their wellbeing. Perfectionism is linked to burnout and "fear of failure", and being "conscientious, high-achieving, driven, self-critical, and obsessional" becomes, at times, counterproductive. The report illuminates the high levels of "self-giving" and emotional involvement often required by postgraduate healthcare students; having to consciously moderate one's emotions to make sure that only the appropriate ones are publicly expressed is also associated with increased stress and burnout.
"Among some postgraduate learners, the term ‘resilience’ has negative connotations, implying that they are emotionally weak. There is also some academic contention regarding the term. Asking individuals to improve their resilience without acknowledging that the system they work within can seem almost designed to foster poor mental health may worsen the relationship between postgraduate learners and their employers", the report says. "Resilience can be seen as having the tools to self-care. This can enable postgraduate learners to accurately perceive emotions, integrate emotions with cognition, understand emotional causes and consequences and manage emotions for personal adjustment".
A "general atmosphere of 'fear'" has been found amongst doctors, with postgraduate students fearing investigation by public bodies such as the General Medical Council (GMC). The Commission notes that, according to GMC reports, BAME and non-UK graduates are more likely to receive sanctions and warnings than their white/UK peers. Studies confirm that more BAME and non-UK graduates are referred to the GMC by employers, and referrals by employers are more likely to result in career-changing consequences than patient complaints. An independent study, commissioned by the GMC, will examine this issue in more depth. The study is due to conclude in early 2019.
Postgraduate students are vulnerable to bullying and harassment - which leads to stress, poor mental health, absence, and presenteeism - due to being potentially less experienced than their colleagues.
In response to the report, Sue Covill, Director of Development and Employment at NHS Employers, said:
“The NHS could not deliver quality care to patients without its staff. It is critical that we understand the needs of staff and learners and the NHS does all it can to support the wellbeing of its workforce. The findings and recommendations of the report continue to highlight the challenging environment in which our staff and learners work in but also the dedication and commitment of our staff to continue to deliver the best care they can to patients.
“We welcome the recommendations and the continued focus on key steps employers and staff can take to support and promote wellbeing.
“NHS trusts are working extremely hard to improve and support the wellbeing of their staff. Where this works well, organisations have strong leadership from their board to drive improvements, influence the culture of the organisation and engage with staff to provide the prevention, support and interventions needed.”
- See more: Join us at our flagship event in May to find out more about accessing mental health support
- See more: Mental health at school: Meditation and morality, or counselling and clinical care?
The Commission makes a total of 33 recommendations on how the wellbeing of NHS staff could be improved. From more standardised procedures to report bullying to a "Samaritans-style" service to support NHS staff, it's clear that there are practical changes that must be made to support people in what is - even at the best of times - often an extremely stressful job. The pressures juggling academia with clinical practice is undoubtedly taxing for both undergraduate and postgraduate healthcare students, and the Commission's report recognises this.
"The current NHS workforce can do more to promote an acceptance that everyone has a continuum of mental health", says the report. A survey of 3,500 doctors showed that 73% would choose to disclose mental ill health to family or friends rather than a healthcare professional - let's hope that implementing the Commission's recommendations will change this.
Read the full report here.